Zhan Jie, Wei Xiaojing, Tao Chenyang, Yan Xiaoting, Zhang Peiming, Chen Rouhao, Dong Yu, Chen Hongxia, Liu Jianhua, Lu Liming
Postdoctoral Research Station, Department of Rehabilitation, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Clinical Research and Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
Front Med (Lausanne). 2022 Oct 4;9:947285. doi: 10.3389/fmed.2022.947285. eCollection 2022.
Post-stroke shoulder pain (PSSP) is characterized by shoulder pain on the hemiplegic side, which can limit physical activity in patients with stroke. Acupuncture combined with rehabilitation training (AR) has been widely used in PSSP, but the evidence of its effectiveness is still unclear.
The study aimed to evaluate the effect and safety of AR vs. rehabilitation training (RT) alone on PSSP.
We searched PubMed, the Cochrane Library, the Chinese Biological Medicine Database (CBM), the Chinese Scientific Journal Database (VIP), China National Knowledge Infrastructure (CNKI), and the WAN FANG database for relevant studies from their inception to February 2022. Only randomized controlled trials (RCTs) comparing the effect of AR with RT alone on PSSP were considered. The primary outcome was shoulder pain. Secondary outcomes included upper limb motor function, activities of daily living (ADL), shoulder range of motion (ROM), and adverse events (AEs). Subgroup analysis and sensitivity analysis were also conducted. Quality assessment was implemented based on Cochrane risk of bias (ROB) criteria, which consist of seven items. When more than four items in a study were judged as low ROB, the overall quality of this study was considered low risk.
A total of 40 studies were included in the qualitative analysis, and 35 (87.5%) studies with 2,554 patients were included in the meta-analysis. Of the 40 studies, 14 (35.0%) were of moderate-to-high quality. The meta-analysis results showed that AR is better than RT alone in reducing shoulder pain (MD -1.32, 95% CI -1.58 to -1.07), improving upper limb motor function (MD 6.81, 95% CI 4.95-8.67), ADL (MD 11.17, 95% CI 9.44-12.91), and shoulder ROM (internal rotation: MD 10.48, 95% CI 8.14-12.83; backward extension: MD 7.82, 95% CI 6.00-9.64; anteflexion: MD 12.88, 95% CI 5.47-20.29; external rotation: MD 11.40, 95% CI 6.17-16.64; abduction: MD 16.96, 95% CI 8.61-25.31) without obvious AEs.
AR may be better than RT alone for the improvement of shoulder pain, upper limb motor function, ADL, and shoulder ROM, without obvious AEs in patients with PSSP. However, considering the clinical and statistical heterogeneity, our findings need to be interpreted with caution. More rigorous RCTs in this area should be conducted in the future.
[www.crd.york.ac.uk], identifier [CRD42022326763].
中风后肩痛（PSSP）的特征是偏瘫侧肩部疼痛，这会限制中风患者的身体活动。针灸联合康复训练（AR）已广泛应用于PSSP，但关于其有效性的证据仍不明确。
本研究旨在评估AR与单纯康复训练（RT）对PSSP的疗效和安全性。
我们检索了PubMed、Cochrane图书馆、中国生物医学数据库（CBM）、中文科技期刊数据库（VIP）、中国知网（CNKI）和万方数据库，以查找从建库至2022年2月的相关研究。仅纳入比较AR与单纯RT对PSSP疗效的随机对照试验（RCT）。主要结局指标为肩部疼痛。次要结局指标包括上肢运动功能、日常生活活动能力（ADL）、肩部活动范围（ROM）和不良事件（AE）。还进行了亚组分析和敏感性分析。基于Cochrane偏倚风险（ROB）标准进行质量评估，该标准包括七个项目。当一项研究中超过四项被判定为低ROB时，该研究的整体质量被认为是低风险。
共有40项研究纳入定性分析，35项（87.5%）研究（2554例患者）纳入荟萃分析。在这40项研究中，14项（35.0%）为中高质量。荟萃分析结果显示，在减轻肩部疼痛（MD -1.32，95%CI -1.58至-1.07）、改善上肢运动功能（MD 6.81，95%CI 4.95 - 8.67）、ADL（MD 11.17，95%CI 9.44 - 12.91）和肩部ROM（内旋：MD 10.48，95%CI 8.14 - 12.83；后伸：MD 7.82，95%CI 6.00 - 9.64；前屈：MD 12.88，95%CI 5.47 - 20.29；外旋：MD 11.40，95%CI 6.17 - 16.64；外展：MD 16.96，95%CI 8.61 - 25.31）方面，AR优于单纯RT，且无明显AE。
对于改善PSSP患者的肩部疼痛、上肢运动功能、ADL和肩部ROM，AR可能优于单纯RT，且无明显AE。然而，考虑到临床和统计异质性，我们的研究结果需要谨慎解读。未来应开展该领域更严格的RCT。
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